Minimally invasive endoscopic foraminal decompression for adult degenerative scoliosis: clinical case study and literature review

Objective. To demonstrate opportunities of minimally invasive surgery in the treatment of deformities in patients with degenerative disease of the spine.
Material and Methods. The clinical case of a 53-year-old female patient with adult degenerative scoliosis accompanied by foraminal stenosis and foraminal disc herniation at the L4–L5 level on the left with L5 root compression was considered. The clinical picture of the disease was carefully analyzed for compliance with the criteria for possibility of minimally invasive intervention as opposed to reconstructive surgery using instrumentation. The nature of the pain syndrome and its intensity according to VAS were determined, preoperative CT and MRI studies were carried out, and functional radiographs to detect signs of instability and the whole spine radiographs to calculate sagittal and coronal balance parameters were taken. A retrospective dynamic assessment of radiological data throughout the disease course was carried out to determine the dynamics of the deformity development. Postoperative follow-up was performed during 6 months. Pain syndrome was assessed according to VAS, and quality of life – according to Oswestry questionnaire. Postoperative CT and MRI studies were performed, and spinal radiographs were taken to calculate sagittal and coronal balance parameters. PubMed data and a number of meta-analyzes were considered to substantiate the choice of treatment.
Results. Six months after surgery, the patient does not complain, is physically active, fully resumed work. She has not pain syndrome (VAS score 0), the Oswestry index is 8 points, neurological and static-dynamic statuses are without negative dynamics. The parameters of coronal and sagittal balance are stable.
Conclusion. Endoscopic foraminal decompression may be the method of choice in the treatment of patients with adult degenerative scoliosis with a dominant clinical picture of monoradicular syndrome and compensated sagittal balance.

endoscopy, minimally invasive surgery, adult degenerative scoliosis, scoliosis, radiculopathy

1. Anand N, Agrawal A, Burger EL, Ferrero E, Fogelson JL, Kaito T, LaGrone MO, Le Huec JC, Lee JH, Mudiyam R, Sasao Y, Sembrano JN, Trobisch PD, Yang SH. The prevalence of the use of MIS techniques in the treatment of adult spinal deformity (ASD) amongst members of the Scoliosis Research Society (SRS) in 2016. Spine Deform. 2019;7:319–324. DOI: 10.1016/j.jspd.2018.08.014.

2. Epstein JA, Epstein BS, Lavive LS. Surgical treatment of nerve root compression caused by scoliosis of the lumbar spine. J Neurosurg. 1974;41:449–454. DOI: 10.3171/jns.1974.41.4.0449.

3. Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res. 2001;(384):45–53. DOI: 10.1097/00003086-200103000-00007.

4. Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, De Wald C, Mehdian H, Shaffrey C, Tribus C, Lafage V. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine. 2012;37:1077–1082. DOI: 10.1097/BRS.0b013e31823e15e2.

5. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine;34:E599–E606. DOI: 10.1097/BRS.0b013e3181aad219.

6. Ploumis A, Transfeldt EE, Gilbert TJ, Mehbod AA, Dykes DC, Perra JE. Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions. Spine. 2006;31:2353–2358. DOI: 10.1097/01.brs.0000240206.00747.cb.

7. Hansraj KK, O’Leary PF, Cammisa FP, Hall JC, Fras CI, Cohen MS, Dorey FJ. Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Clin Orthop Relat Res. 2001;(384):18–25. DOI: 10.1097/00003086-200103000-00004.

8. Telfeian AE, Oyelese A, Fridley J, Gokaslan ZL. Transforaminal endoscopic decompression in the setting of lateral lumbar spondylolisthesis. World Neurosurg. 2018;117:321–325. DOI: 10.1016/j.wneu.2018.06.106.

9. Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine. 1993;18:700–703. DOI: 10.1097/00007632-199305000-00004.

10. Haher TR, O’Brien M, Dryer JW, Nucci R, Zipnick R, Leone DJ. The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading. Spine. 1994;19:2667–2671. DOI: 10.1097/00007632-199412000-00012.

11. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine. 2009;34:2171–2178. DOI: 10.1097/BRS.0b013e3181a8fdc8.

12. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine. 2009;34:1693–1698. DOI: 10.1097/BRS.0b013e3181ac5fcd.

13. Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine. 2000;25:2808–2815. DOI: 10.1097/00007632-200011010-00014.

14. Fujii K, Kawamura N, Ikegami M, Niitsuma G, Kunogi J. Radiological improvements in global sagittal alignment after lumbar decompression without fusion. Spine. 2015;40:703–709. DOI: 10.1097/BRS.0000000000000708.

15. Akinduro OO, Kerezoudis P, Alvi MA, Yoon JW, Eluchie J, Murad MH, Wang Z, Chen SG, Bydon M. Open versus minimally invasive surgery for extraforaminal lumbar disk herniation: a systematic review and meta-analysis. World Neurosurg. 2017;108:924–938.e3. DOI: 10.1016/j.wneu.2017.08.025.

16. He J, Xiao S, Wu Z, Yuan Z. Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J. 2016;25:1373–1381. DOI: 10.1007/s00586-016-4523-3.

17. Li XC, Zhong CF, Deng GB, Liang RW, Huang CM. Full-endoscopic procedures versus traditional discectomy surgery for discectomy: a systematic review and meta-analysis of current global clinical trials. Pain Physician. 2016;19:103–118.

18. Eastlack RK, Srinivas R, Mundis GM, Nguyen S, Mummaneni PV, Okonkwo DO, Kanter AS, Anand N, Park P, Nunley P, Uribe JS, Akbarnia BA, Chou D, Deviren V. Early and late reoperation rates with various MIS techniques for adult spinal deformity correction. Global Spine J. 2019;9:41–47. DOI: 10.1177/2192568218761032.

19. Bae J, Lee SH. Minimally invasive spinal surgery for adult spinal deformity. Neurospine. 2018;15:18–24. DOI: 10.14245/ns.1836022.011.

20. Wegner AM, Prior DM, Klineberg EO. Minimally invasive lateral approach for the management of adult degenerative scoliosis. Instr Course Lect. 2017;66:367–377.

21. Telfeian AE, Oyelese A, Fridley J, Gokaslan ZL. Transforaminal endoscopic decompression in the setting of lateral lumbar spondylolisthesis. World Neurosurg. 2018;117:321–325. DOI: 10.1016/j.wneu.2018.06.106.

22. Fontes RB, Fessler RG. Lumbar radiculopathy in the setting of degenerative scoliosis: MIS decompression and limited correction are better options. Neurosurg Clin N Am. 2017;28:335–339. DOI: 10.1016/j.nec.2017.02.003.

23. Kolesov SV. Surgical Treatment of Spinal Deformity, ed. by S.P. Mironov. Moscow, 2014. In Russian.

24. Eck JC, Hodges S, Humphreys SC. Minimally invasive lumbar spinal fusion. J Am Acad Orthop Surg. 2007;15:321–329.

25. Lau D, Lee JG, Han SJ, Lu DC, Chou D. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci. 2011;18:624–627. DOI: 10.1016/j.jocn.2010.09.004.

26. Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop. 2009;33:1683–1688. DOI: 10.1007/s00264-008-0687-8.

27. Ntoukas V, Muller A. Minimally invasive approach versus traditional open approach for one level posterior lumbar interbody fusion. Minim Invasive Neurosurg. 2010;53:21–24. DOI: 10.1055/s-0030-1247560.

28. Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine. Eur Spine J. 2011;20:623–628. DOI: 10.1007/s00586-010-1578-4.